AT Abatement
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Your Email Address
example@example.com
Jobsite / City
Job Number
General Contractor
Foreman
First Name
Last Name
Project Manager
First Name
Last Name
Describe the job(s) to be accomplished today:
Identify the hazards of the job (consider probability, severity & prevention), select all that apply:
Working from heights (scaffolding, scissor lifts, aerial lifts, ladders)
Falling objects, struck-by vehicles, other
Caught-in hazards, cave-ins, machinery
Electrical equipment & building utilities
Bobcat, forklift, other wheeled equipment
Welding and cutting
Structural issues – walls, ceilings, roofs
Confined space entry or excavations
Fire prevention plans
Debris removal – control area, material
Describe the hazards & safety controls for working from heights:
Describe the hazards & safety controls for falling objects, struck-by vehicles, other:
Describe the hazards & safety controls for caught-in hazards, cave-ins, machinery:
Describe the hazards & safety controls for electrical equipment & building utilities:
Describe the hazards & safety controls for Bobcat, forklift, other wheeled equipment:
Describe the hazards & safety controls for welding and cutting:
Describe the hazards & safety controls for structural issues – walls, ceilings, roofs:
Describe the hazards & safety controls for confined space entry or excavations:
Describe the hazards & safety controls for fire prevention plans:
Describe the hazards & safety controls for debris removal – control area, material:
Personal protective equipment checklist (check required PPE)
Hard hat
Safety glasses w/ side shields
Shield / goggles / added face protection
Foot protection
Respiratory (describe type above)
Hand protection
Hearing protection
Clothing (long pants, long sleeves, etc.)
Submit
Should be Empty: